Cross validation with the mood disorder questionnaire (MDQ) of an instrument for the detection of hypomania in Brazil: The 32 item hypomania symptom check-list, first Revision (HCI-32-R1)

Assessment of the diagnostic performance of various screening tools for bipolar disorder: a meta-analysis

Background

Various studies have shown that about 40–50% of patients with bipolar disorder (BD) are undiagnosed at the time of referral and are often treated as depression. The present meta-analysis was conducted to determine the diagnostic accuracy of psychometric properties of the bipolarity index (BI) in people with BD.

Methods

We systematically searched databases including, Scopus, ISI Web of Sciences (WOS), Pubmed/Medline, Embase, and PsycINFO using standard search terms.

Results

Two hundred and ninety-six records were found through the initial search. Of 679 articles, 25 duplicated studies were found and 70 were omitted due to the irrelevant titles and abstracts. The rest 450 were entered the full-text screening, of which 186 were excluded due to pre-defined inclusion criteria. Ultimately, 15 studies on 6525 patients were included. Our findings showed that the pooled sensitivity of BI in the diagnosis of BD was 0.82 (95%CI: 0.81–0.83, P < 0.0001, I2 = 99%), while the pooled specificity also was 0.73 (95%CI: 0.72–0.74, P = 0.000, I2 = 99%). The BI was significantly more accurate than the other tests with a pooled DOR of 47.2 (95%CI: 12.01–85.52, P = 0.0000, I2 = 99.2%).

Conclusion

BI appears to be a useful screening instrument with suitable psychometric properties to identify BD compared to both the MDQ and the HCL-32. Consequently, patients detected by the BI should be confirmed through diagnostic interviews. Thus, more studies are needed to explore the optimal cut-off values of BI among screened populations during long-term follow-up, since a considerable portion of individuals primarily diagnosed with major depressive disorders could have BD.

Psychometric Properties of the Perinatal Anxiety Screening Scale Administered to Italian Women in the Perinatal Period

Literature stressed the importance of using valid, reliable measures to assess anxiety in the perinatal period, like the self-rated Perinatal Anxiety Screening Scale (PASS). We aimed to examine the psychometric properties of the Italian PASS version in a sample of Italian women undergoing mental health screening during their third trimester of pregnancy and its diagnostic accuracy in a control perinatal sample of psychiatric outpatients. Sample comprised 289 women aged 33.17 ± 5.08, range 19-46 years, undergoing fetal monitoring during their third trimester of pregnancy, with 49 of them retested 6 months postpartum. Controls were 60 antenatal or postnatal psychiatric outpatients aged 35.71 ± 5.02, range 22-50 years. Groups were assessed through identical self- and clinician-rating scales. Confirmatory Factor Analysis (CFA), Principal Component Analysis (PCA), Pearson's correlations and receiver operating characteristic were conducted for PASS. PCA and CPA confirmed four-factor structure with slight differences from the original version. Construct validity and test-retest reliability were supported. Cut-off was 26. The PASS correlated with principal anxiety scales. Despite small sample size, findings confirm reliability and validity of the Italian PASS version in assessing anxiety symptoms in the perinatal period. Its incorporation in perinatal care will improve future mother and child psychological health.

Association of occupational burnout and occupational exposure factors on psychological health among factory workers and miners: a propensity score analysis

PURPOSE

This study is to explore the association of occupational burnout and occupational exposure factors on psychological health among factory workers and miners.

METHODS

A total of 6130 factories workers and miners in Urumqi, China were included using a cluster sampling method. The occupational burnout and psychological health were investigates using the Chinese Maslach Burnout Inventory (CMBI) and the Symptom Check List-90 (SCL-90). The propensity score analysis (PSA) was used to eliminate the influence of individual characteristics, and 2164 pairs of participants on psychological healthy and unhealthy were matched. After PSA, the relationship between occupational burnout, occupational hazard exposure, and psychological health was evaluated.

RESULTS

The results showed that asbestos dust (OR 1.65, CI 95% 1.35-2.02) and CMBI (OR 2.59, CI 95% 2.39-2.83) were risk factors affecting psychological health (P < 0.001).

CONCLUSIONS

Measures need to be taken to ease occupational burnout among factories workers and miners, and strengthen personal protection to improve their psychological health.

The Status of Occupational Burnout and Its Influence on the Psychological Health of Factory Workers and Miners in Wulumuqi, China

The purpose of this study was to investigate the status of occupational burnout and its influence on the psychological health of factory workers and miners, in order to provide theoretical basis and reference for alleviating occupational burnout and promoting psychological health. The cross-sectional study investigated 6130 factory workers and miners with online questionnaire; the Chinese Maslach Burnout Inventory (CMBI) and Symptom Check List-90 (SCL-90) were used. In total, 6120 valid questionnaires were collected; effectiveness was 99.8%. The percentage of the factory workers and miners suffering from occupational burnout was 85.98% and psychological health problems was 38.27%. A statistically significant difference was observed in relation to the prevalence of occupational burnout among factory workers and miners of different sex, education level, labor contracts, work schedule, monthly incomes, weight, hypertension, age, working years, working hours per day, working hours per week, coal dust, silica dust, asbestos dust, benzene, lead, and noise. The detection rate of psychological health was higher for males than females. The detection rate of psychological health was higher for working days per week less than 5 days than more than 5 days. The detection rate of psychological health with high school education, senior professional title, night shift, divorced, monthly income less than 3000 yuan, weight more than 75 kg, age more than 45 years, and working years between 25 and 30 years was higher than that of the other groups. The results showed that sex, education level, professional title, work schedule, monthly income, hypertension, age, working years, asbestos dust, benzene, and occupational burnout affected psychological health among factory workers and miners. Factory workers and miners had high levels of occupational burnout, and occupational burnout was a risk factor that can lead to psychological health.

Screening for psychiatric disorders with self-administered questionnaires

Given the time demands of clinical practice it is not surprising that diagnoses are sometimes missed. To improve diagnostic recognition, self-administered screening scales have been recommended. A problem with much of the research effort on screening scales is the confusion between diagnostic testing and screening. It is important for a screening test to have high sensitivity because the more time intensive/expensive follow-up diagnostic inquiry will presumably only occur in patients who are positive on the initial screen. Investigators vary in how they analyze their data in determining the recommended cutoff score on a self-administered screening questionnaire. To illustrate this, in the present report we examined how often each of the different approaches towards determining a cutoff score on bipolar disorder screening scales were used. We reviewed 68 reports of the performance of the 3 most commonly researched bipolar disorder screening scales to determine how the recommended cutoff on the scale was derived. Most studies recommended a cutoff point on the screening scale that optimized the level of agreement with the diagnostic gold standard. Only 11 (16.2%) studies recommended a cutoff that prioritized the scale's sensitivity. It is important for clinicians to understand the difference between screening and diagnostic tests. The results of the present study indicate that most studies of the performance of the 3 most commonly studied bipolar disorder screening measures have taken the wrong approach in deriving the cutoff score on the scale for the purpose of screening.

Hypomania Symptoms Across Psychiatric Disorders: Screening Use of the Hypomania Check-List 32 at Admission to an Outpatient Psychiatry Clinic

Introduction: Hypomania symptoms are best described as a continuum, ranging beyond Bipolar Spectrum Disorders (BSD). Other nosological entities, such as major depressive disorder, schizoaffective disorder, or borderline personality disorder, may also share symptoms with BSD, raising challenges for differential diagnosis. While the Hypomania Checklist-32 is one of the most widely used tools for screening hypomania, there is limited evidence describing its use in a real-world outpatient psychiatric clinical setting. Methods: Here we tested the psychometric properties of a European Portuguese adaptation of the HCL-32, establishing its factor structure, reliability and construct validity. Furthermore, we analyzed differences in hypomanic symptoms among several clinical groups and in a non-clinical sample. Data was obtained retrospectively in an ecological setting from a clinical sample of an outpatient psychiatry and psychology clinic, comprising 463 Portuguese individuals, 326 of whom had a psychiatric diagnosis, namely BSD (n = 66), major depressive disorder (n = 116), or other psychiatric disorders (n = 144). A separate non-clinical sample was also collected among healthy volunteers (n = 62). A battery of self-report measures of affective symptoms was applied, and in a subset of patients, diagnosis was established using a structured diagnostic interview. Results: Psychometric properties of the HCL-32 were adequate, with good internal consistency (Cronbach's α = 0.86) and test-retest stability (ICC = 0.86), and two subscores ("active/elated" and "risk-taking/irritable") defined by Principal Component Analysis. Receiver Operating Characteristic curve analysis demonstrated that the test score discriminated moderately between patients with BSD and other clinical samples as well as healthy volunteers, with a cut-off score of 17 for the total score of the HCL-32 rendering the best combination of sensitivity and specificity. When compared to the HCL-32 total score, the risk-taking/irritable subscore seems to provide additional benefit in discriminating between different clinical groups, namely regarding specificity in the discrimination from patients with a diagnosis of major depressive disorder that was low for the full scale and the alternate subscale. Conclusions: HCL-32 can be used as a screening tool for BSD among adult patients presenting in an outpatient psychiatric clinical setting.

Relationship between Chinese adjective descriptors of personality and emotional symptoms in young Chinese patients with bipolar disorders

OBJECTIVE

To investigate whether personality traits are related to emotional symptoms (mania, hypomania, and depression) in Chinese patients with bipolar disorders.

METHODS

Patients with bipolar I and II disorders, and healthy volunteers, were assessed using the Chinese Adjective Descriptors of Personality (CADP) questionnaire, Mood Disorder Questionnaire (MDQ), Hypomanic Checklist (HCL-32), and Plutchik-van Praag Depression Inventory (PVP).

RESULTS

Seventy-three patients with bipolar I disorder, 35 with bipolar II disorder and 216 healthy controls were included. Bipolar I and II groups scored significantly higher on MDQ, HCL-32 and PVP scales than controls; the bipolar II group scored lower on the MDQ, but higher on the HCL-32 and PVP than bipolar I. In the bipolar I group, the CADP Intelligent trait (β, 0.25) predicted MDQ; Intelligent (β, -0.24), Agreeable (β, 0.22) and Emotional (β, 0.34) traits predicted PVP. In the bipolar II group, Intelligent (β, 0.22), Agreeable (β, -0.24) and Unsocial (β, 0.31) traits predicted MDQ; Intelligent (β, -0.20), Agreeable (β, -0.31) and Emotional (β, -0.26) traits predicted HCL-32.

CONCLUSIONS

Four out of five Chinese personality traits were associated with emotional symptoms in patients with bipolar I or II disorder, but displayed different associations depending on disorder type.

The Hypomania Checklist (HCL) - systematic review of its properties to screen for bipolar disorders

OBJECTIVE

Bipolar disorders (BDs) are often not recognised with potentially drastic consequences for the individuals and their families. In clinical practice self-reports can be used to screen to enhance recognition. We therefore present a systematic review of the screening properties for the Hypomania Checklist (HCL-32).

METHODS

A systematic literature search was conducted to identify all relevant studies looking at the screening properties of the HCL-32 in adults.

RESULTS

Out of 196 papers 21 papers reported data on 22 independent samples. We narratively reviewed these studies. Weighted estimated Sensitivity was 80% regardless of whether a BD diagnosis was compared to unipolar depression or any other non-bipolar diagnosis. Specificity indicated that the HCL-32 was better when comparing BD to unipolar depression (65.3%) than to any other diagnostic category (57.3%). Fewer studies provided estimates for predictive powers, leading to less reliable overall estimates for these indicators.

CONCLUSIONS

Despite some limitations, using the HCL-32 as a first screening in patients seeking help for depression can be recommended, but should never be used on its own for diagnosing. Future research should examine whether screening properties can be improved by developing an algorithm incorporating the negative consequences reported for different areas in the HCL-32.

Bipolar II disorder in patients with a current diagnosis of recurrent depression

OBJECTIVES

The prevalence of bipolar II disorder (BD-II) in Russia has never been studied. Therefore, we sought to identify patients meeting diagnostic criteria for BD-II among patients with a current diagnosis of recurrent depressive disorder (RDD) through the use of the Russian versions of the Hypomania Checklist (HCL-32) and Bipolarity Index scales for differentiating between BD-II and RDD.

METHODS

In a non-interventional diagnostic study, we selected 409 patients aged between 18 and 65 years from two medical settings with (i) a current diagnosis of RDD, (ii) an illness duration of at least three years, and (iii) at least two affective episodes. The diagnosis was based on clinical assessment and confirmed by the Russian version of the Mini International Neuropsychiatric Interview. All patients were assessed by the HCL-32, the Bipolarity Index, and the Personal and Social Performance Scale.

RESULTS

Among patients with a current diagnosis of RDD, 40.8% had a diagnosis of bipolar disorder (bipolar I disorder: 4.9%; BD-II: 35.9%). The average time lag from onset to a correct diagnosis of BD-II was 15 years and patients were treated only with antidepressants. The sensitivity of the Russian version of the HCL-32 at the optimal cutoff point (≥14.0) was 83.7%, and its specificity was 71.9%. The Bipolarity Index showed significant differences between the total scores of the patients with BD-II and RDD (31.8 versus 20.2; p < 0.0001). The optimal threshold was ≥22.0 (sensitivity 73.5%; specificity 72.3%).

CONCLUSIONS

In Russia, diagnostic errors are an important cause of the non-detection of bipolar disorder, particularly BD-II. The Russian version of the HCL-32 and the Bipolarity Index, as additional tools, could be useful for bipolarity screening.

Validation of the Russian version of the Hypomania Checklist (HCL-32) for the detection of Bipolar II disorder in patients with a current diagnosis of recurrent depression

BACKGROUND

There are no validated screening tools for Bipolar Disorder (BD) in Russia.

OBJECTIVE

To validate the Russian version of the HCL-32 for the detection of Bipolar II disorder (BD II) in patients with Recurrent Depressive Disorder (RDD).

METHODS

409 patients with a current diagnosis of RDD were recruited. The diagnosis was confirmed by the validated Russian version of the Mini International Neuropsychiatric Interview (MINI). Another investigator interviewed the patients using the НСL-32 questions.

RESULTS

The total HCL-32 score in patients with BD II was significantly higher than in patients with RDD: 18.2 (4.22) versus 10.85 (5.81) (p<0.001, d=1447). At the cut-off 14 points the sensitivity was 83.7%, specificity 71.9% (p<0.001). The Cronbach's alpha was 0.887 that means good internal consistency. The best discrimination was achieved with 8 items: decreased need for sleep, less shyness or inhibition, talkativeness, more jokes and puns, jumping thoughts distractibility, exhausting or irritating others and high and more optimistic mood. We proposed the reduced variant of the scale, that includes only these 8 variables, with sensitivity 90.5%, specificity 69.8% (AUC=0.88).

CONCLUSIONS

The Russian version of the HCL-32 displayed a good ratio of sensitivity to specificity and can be recommended as a validated screening instrument. An 8-item version of HCL needs further research.

LIMITATIONS

Limitations include the specific nature of the sample, the HCL-32 assessment carried out by a psychiatrist, no comparison with other BD screening scales. The results of the 8-item version may be sample and culture dependent.